Polyamory, Schizophrenia, and other psychotic disorders (Part 1)

This post and others discussing specific mental disorders will reference the Diagnostic and Statistical Manuel of Psychiatry and Psychology, Edition Five (DSM-V). Apologies to my international readers, I’m just not familiar enough with the ICD to use it as a reference.

Please note: everyone’s experience of mental illness is different. This is general information meant to give you an idea of what to expect. Nothing in this blog is intended to diagnose or treat. Please see a psych professional if you or someone you love may be suffering from a mental illness.

The Psychotic Disorders

1. Delusional disorder
2. Brief psychotic disorder
3. Schizophreniform disorder
4. Schizophrenia
5. Schizoaffective disorder
6. Other

Delusional disorder, as the name says, involves delusions specifically. Brief psychotic disorder is for what seems to be an episode of schizophrenia that lasts less than a month. Schizophreniform is if it lasts less than 6 months. Schizoaffective disorder is when the primary diagnosis is mood related (primarily depression or bipolar) but there are psychotic symptoms. And of course schizophrenia a long term disorder manifesting multiple symptoms of psychosis.

Symptoms of Schizophrenia and Psychotic disorders

There are five features that define psychotic disorders in DSM-5. Delusions are fixed beliefs that cannot be changed by evidence that contradicts them. Hallucinations are sensing something (usually seeing and/or hearing, but sometimes tactile or taste/smell) that isn’t there. Disorganized thinking (speech) means not being able to follow a conversational topic, lack of coherence in speech, or loose associations. Grossly disorganized or abnormal motor behavior (including catatonia) is when the body doesn’t move right and/or doesn’t move at all, when there is no physical illness to explain the problem. Finally what are called negative symptoms–lack of emotional expression, lack of speech, inability to motivate or direct oneself in completing tasks, not being able to feel pleasure from normally pleasurable experiences, and lack of motivation to socialize/interact with other people.

Interestingly, the way symptoms manifest can change depending on the culture a person is living in. In the US today, hallucinations from psychotic disorders are often terrifying experiences. Voices telling you to kill someone else or kill yourself, threats, personal attacks, and other really nasty things are common. However, 100 years ago most hallucinations where benign. The voice of your dead relative, or a saint, or an angel were common. And in other parts of the world, hallucinations often continue to be benign, usually harmless but sometimes actually supportive.

Society has a long history of demonizing people with schizophrenia and psychotic disorders. We need to remember that, like all mental illness, schizophrenia and other psychotic disorders grow out of healthy (or at least normal) mental processes. Most people have had that time walking home at night when they would swear someone was following them–but if you turned around you were alone, many of us got home and locked the door “just to be safe” (delusion). Almost everyone, at one time or another, has heard their name called when no one was calling them (hallucination). Everyone I’ve ever met has had days where their thoughts are disorganized and they can’t follow a conversation. For most of us, these things pass in a few moments or a few hours and laugh at ourselves and go on with our lives. We all have days when we just don’t want to deal with other people or have trouble motivating ourselves to get shit done (I know I’m not the other person who procrastinated my entire way through Freshman year.)

People with psychotic disorders can be scary. Not gonna lie about that. But the world they are living in is far more frightening for them than they are for you. So if you do meet or know someone who has a psychotic disorder, please start with compassion.

Treatment

Medication

Medication is the primary treatment for psychotic disorders. Antipsychotic medications are divided “conventional” and “atypical.” Conventional antipsychotics are older medications with a higher rate of severe side effects. Atypical antipsychotics are newer medications with significantly reduce side effects. Unfortunately, conventional antipsycotics are much cheaper. When dealing with a medication which will likely be lifelong, price can be a significant concern.

Therapy

So far, no therapy has been found that helps the symptoms of psychotic disorders. However, therapy has been very effective in helping people manage their symptoms. It is especially important for people with schizophrenia to recognize when stress in their life might trigger an acute phase. Preventing the occurrence of an acute phase by managing stress and recognizing early warning signs can be key to successfully managing schizophrenia.

Social skills training and vocational rehabilitation can be important treatments as well, especially for people with long term psychotic disorders.

Other treatments

I don’t know enough about alternative treatments (either alternative therapies such as art and music therapy or alternative medicine such as meditation, herbs, and massage) for psychotic disorders. If you or a loved one wants to explore alternative treatments, start by talking with your psychiatrist and psychologist.

Schizophrenia and Bipolar Disorder

I don’t know what the relationship is between schizophrenia and bipolar disorder. Officially, there isn’t one. But there has to be some reason they are so consistently misdiagnosed as each other. Again, culture seems to play a role–an American diagnosed as schizophenic who moved to Britain will usually be diagnosed by a British doctor as bipolar. The opposite often happens when a British person comes to America. With in America, it is very common for someone to go years thinking they have schizophrenia, make little or no progress in treatment, then have a new doctor diagnosis them with bipolar and the treatments for bipolar start working. Again, the opposite (someone diagnosed bipolar gets a new diagnosis of schizophrenia and stars seeing improvement) happens just as frequently.

If you look at the diagnostic criteria for schizophrenia and bipolar this makes no sense. There is nothing in bipolar about hallucinations or delusions or general motor problems. And nothing in schizophrenia’s criteria about mood swings. I don’t get it. But it’s something to be aware of.

Okay, usually I’d start talking about the impact of psychotic disorders on polyamory here, but that’s gonna be a very long discussion, so we’ll save it for next week.

Thanks to Richard Sprott for providing the diagnostic criteria for schizophrenia.

This post is part of the Polyamory and Mental Illness blog series.

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